Hubble Sheena M A, Kyte Hayley L, Gooding Kim, Shore Angela C
Centre for Clinical and Microvascular Research, Institute of Clinical and Biomedical Science, Peninsula Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK.
Microcirculation. 2009 Feb;16(2):183-91. doi: 10.1080/10739680802461935.
As sublingual microvascular indices are increasingly heralded as new resuscitation end-points, better population data are required to power clinical studies. This paper describes improved methods to quantify sublingual microvessel flow and density in images obtained by sidestream dark field (SDF) technology in healthy volunteers, including vessels under 10 microm in diameter.
Measurements of sublingual capillary density and flow were obtained by recording three 15-second images in 20 healthy volunteers over three days. Two independent observers quantified capillary density by using two methods: total vessel length (mm/mm2) and counting (number/mm). Both intraoral and temporal variabilities within subject and observer reproducibilities were determined by using coefficients of variability and reproducibility indices.
For small (1-10 microm), medium (11-20 microm), and large (21-50 microm) diameter, mean vessel density with standard deviations (SDs) in volunteers was 21.3(+/- 4.9), 5.2 (+/- 1.2), and 2.7 (+/- 0.9) mm/mm2, respectively. Also, 94.0 +/- 1.4% of small vessels, 94.5 +/- 1.4% of medium vessels, and 94.5+/- 4.0% of large vessels had continuous perfusion. Within subjects, the means of all measurements over three days varied less than 13, 22, and 35% in small, medium, and large vessels, respectively. Interobserver reproducibility was good, especially for capillary (1-10 microm) density and flow measurements.
Our methods of microvessel flow and density quantification have low observer variability and confirm the stability of microcirculatory measurements over time. These results facilitate the development of SDF-acquired sublingual microvascular indices as feasible microperfusion markers in shock resuscitation.
由于舌下微血管指标越来越多地被视为新的复苏终点，因此需要更好的人群数据来支持临床研究。本文介绍了改进的方法，用于量化健康志愿者通过侧流暗视野（SDF）技术获得的图像中的舌下微血管流量和密度，包括直径小于10微米的血管。
在三天内对20名健康志愿者记录三张15秒的图像，以测量舌下毛细血管密度和流量。两名独立观察者使用两种方法量化毛细血管密度：总血管长度（mm/mm²）和计数（数量/mm）。通过使用变异系数和再现性指数来确定受试者内部的口内和时间变异性以及观察者的再现性。
对于直径小（1 - 10微米）、中（11 - 20微米）和大（21 - 50微米）的血管，志愿者的平均血管密度及其标准差分别为21.3（±4.9）、5.2（±1.2）和2.7（±0.9）mm/mm²。此外，94.0±1.4%的小血管、94.5±1.4%的中血管和94.5±4.0%的大血管具有连续灌注。在受试者内部，三天内所有测量的平均值在小、中、大血管中分别变化小于13%、22%和35%。观察者间的再现性良好，尤其是对于毛细血管（1 - 10微米）密度和流量测量。
我们的微血管流量和密度量化方法具有低观察者变异性，并证实了微循环测量随时间的稳定性。这些结果有助于将通过SDF获得的舌下微血管指标开发为休克复苏中可行的微灌注标志物。
